Should we treat silent myocardial ischaemia?

Silent myocardial ischaemia has been documented in various clinical entities. Exercise testing and ambulatory ECG monitoring are the most widely used tests for documenting silent ischaemia, and both exercise-induced and daily life ischaemia have the potential to trigger prolonged functional and structural changes. Numerous clinical investigations in apparently healthy subjects, in stable and unstable angina, in patients with a previous myocardial infarction indicate that ischaemia has an adverse prognostic influence, independent of whether the ischaemia is silent or symptomatic. Methods for documenting silent ischaemia lead to different considerations according to each clinical syndrome of coronary artery disease. This review deals with the different intervention strategies derived from the unique prognostic profiles offered by silent ischaemia in a variety of clinical entities.